Mexican Americans' Receptiveness to Hospice
Background: Hospice offers improved pain control and quality of life. Yet, only 6% of hospice users nationwide are Hispanic. Cultural influences within particular Hispanic subgroups may influence their receptiveness to hospice. In the U.S., 64% of Hispanics are Mexican American (MA). To improve their quality of health care at end of life (EOL), it is important to understand any EOL MA cultural preferences. Traits sometimes attributed to MAs such as family decision making and the tendency to shield elders from knowledge of terminal prognosis may clash with the requirement to acknowledge a six month prognosis for hospice enrollment.
Methods: A Medline, CINAHL and Scopus literature search was conducted using the keywords Hispanic American, or Mexican American, combined with hospice care, hospice nursing, palliative care, palliative nursing, terminal care, decision making, prognosis, diagnosis, “truth telling,” or “end of life.” Resulting articles were screened by title and abstract to exclude articles unrelated to hospice or EOL. Articles were closely read for inclusion based on either an exclusive MA focus or a Hispanic or Latino focus where the sample explicitly included MAs. Articles were excluded if participants were solely pediatrics or adolescents, caregivers, or non-MA subgroups. Twenty-three articles remained for review.
Outcomes: Study designs were mainly surveys or low inference qualitative descriptive. Considerable heterogeneity in scales rendered comparisons across studies difficult. The majority of studies were conducted in urban areas with large MA populations, neglecting marginalized and isolated populations. Only six articles focused solely on individuals over age 65, overlooking the views of a large group of potential hospice users. No articles measured or examined the views of MAs who were actually hospice patients. However, some focused on healthy, young, literate and highly acculturated MAs, who reported a greater receptiveness to hospice than their counterparts. Several articles explored preferences for comfort care, which is similar to hospice care in that it involves relinquishing life sustaining therapies (LST). In general, attitudes toward comfort care were mixed when compared to other ethnicities. However, a strong majority of relatively healthy elderly MAs would choose comfort care instead of LST in hypothetical scenarios involving no recovery. More than Whites, communication dynamics among MAs at EOL tend to consistently involve family, shared and passive decision-making, as well as avoidance of direct discussion of terminal prognosis. Hospice utilization rates by MAs may be affected by disease type and abundance of MAs in the population.
Conclusions/Implications: More research is needed from regions sparsely populated by MAs as well as on the relationship between disease type and hospice utilization. Future research should include intervention and richly detailed qualitative studies with elderly MAs and their families because EOL themes may be overlooked by translated survey questions and low inference semi-structured interviews. Being mindful not to stereotype, providers should remain alert to cultural differences between the dominant healthcare system and the increasing number of MAs in the EOL context, particularly with respect to decision making and prognostic disclosure.